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Published on: March 11, 2018
Cerebral hyperperfusion syndrome after stenting for revascularization of intracranial internal carotid artery
Takayuki Funatsu1, Hirotoshi Imamura1, Shoichi Tani1
1Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
Insights
Cerebral hyperperfusion syndrome (CHS) can occur after revascularization procedures. This case highlights CHS risk even after short-term hypoperfusion in intracranial arterial dissection.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Surgery
Background:
- Cerebral hyperperfusion syndrome (CHS) is a known complication following cerebral revascularization.
- Impaired cerebral autoregulation due to prolonged hypoperfusion is the primary suspected cause of CHS.
- Intracranial arterial dissection (IAD) associated with internal carotid artery stenosis presents a unique clinical challenge.
Observation:
- A 40-year-old male with symptomatic IAD and severe cerebral hypoperfusion underwent intracranial stenting.
- The patient developed CHS with an intracerebral hemorrhage post-operatively.
- This event occurred 11 days after the initial onset of symptoms.
Findings:
- Intracranial stenting in the context of IAD-related stenosis carries a risk of CHS.
- Even brief periods of cerebral hypoperfusion may predispose patients to developing CHS.
- The pathophysiology may involve rapid changes in cerebral blood flow and autoregulation.
Implications:
- This case expands the understanding of CHS risk factors beyond long-standing hypoperfusion.
- It underscores the importance of careful patient selection and monitoring after intracranial stenting for IAD.
- Further research is warranted to elucidate the mechanisms of CHS in acute hypoperfusion scenarios.
Abstract:
Cerebral hyperperfusion syndrome (CHS) is one of the complications of cerebral revascularization. The main pathophysiology of CHS was considered to be cerebral autoregulation impairment due to long-standing cerebral hypoperfusion. Herein, we describe the case of a 40-year-old man with symptomatic intracranial arterial dissection (IAD) related to internal carotid artery stenosis. The patient underwent intracranial stenting 11 days after onset due to severe cerebral hypoperfusion presenting with neurological symptoms, and CHS presenting with intracerebral hemorrhage, post-operatively. The present case indicated not only the potential risk of CHS after intracranial stenting in IAD-related stenosis but also that cerebral hypoperfusion-even in a short period-might lead to CHS.
